Individual
LAWRENCE J FOGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
628 CALIFORNIA BLVD, SUITE A-3, SAN LUIS OBISPO, CA 93401-2542
(805) 543-1683
(805) 543-3516
Mailing address
628 CALIFORNIA BLVD, SUITE A-3, SAN LUIS OBISPO, CA 93401-2542
(805) 543-1683
(805) 543-3516
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G18977
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G189770
BLUE SHIELD
CA
05
—
00G189770
—
CA
01
—
120995100
US DEPT OF LABOR
CA
Enumeration date
11/29/2005
Last updated
09/23/2011
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